Post-Traumatic Stress Disorder

Topic Overview

What is PTSD?

Post-traumatic stress disorder (PTSD) can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.

Anyone who has gone through a life-threatening event can develop PTSD. But people don't always have to see a traumatic event or have it happen to them to get PTSD. Sometimes learning that a traumatic event happened to a loved one can cause PTSD.

These events can include:

• Physical violence.
• Sexual violence, such as sexual assault (rape).
• Serious injuries, such as a car wreck.
• Natural disasters, such as a fire, tornado, flood, or earthquake.
• Combat, or being sent to a combat zone.
• Military sexual trauma.
• Terrorist attacks.
• Life-threatening illnesses, such as cancer.
• Living in or near an area affected by conflict, such as war.

After the event you might find that you are thinking a lot about what happened, avoiding reminders about the event, and thinking negative thoughts about yourself and the world.

What are the symptoms?

After going through a traumatic event, you may:

• Feel upset by things that remind you of what happened.
• Have nightmares, vivid memories, or flashbacks of the event. You may feel like it's happening all over again.
• Avoid places or things that remind you of what happened.
• Often feel bad about yourself and the world.
• Feel numb or lose interest in things you used to care about.
• Feel that you are always in danger.
• Feel anxious, jittery, or irritated.
• Have trouble sleeping or keeping your mind on one thing.

PTSD symptoms can change your behaviour and how you live your life. You may pull away from other people, work all the time, or use drugs or alcohol. You may find it hard to be in relationships, and you may have problems with your spouse and family. You may become depressed. Some people with PTSD also have panic attacks, which are sudden feelings of fear or worry that something bad is about to happen.

Children can have PTSD too. They may have the symptoms above and symptoms that depend on how old they are. As children get older their symptoms are more like those of adults.

• Young children may become upset if their parents are not close by. Or children may have trouble sleeping or suddenly have trouble with toilet training or going to the washroom.
• Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event.

What can you do if you think you have PTSD?

If you think you have PTSD, it's important to get treatment. Treatment can work, and early treatment may help reduce long-term symptoms.

If you think you have PTSD:

• Talk to your family doctor.
• Talk to a mental health professional, such as a therapist.
• If you're a veteran, contact Veterans Affairs Canada.
• Talk to a close friend or family member. He or she may be able to support you and find you help.
• Talk to a religious leader.

If you have thoughts about hurting yourself or someone else, call 911 , check your local phone book or provincial website for resources on getting helpin your area, or go to a hospital emergency room.

How does PTSD develop?

All people with PTSD have personally experienced—or have experienced through others—a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD.

Many people who go through a traumatic event don't get PTSD. It isn't clear why some people develop PTSD and others don't. How likely you are to get PTSD depends on many things. These include:

• How intense the trauma was.
• If you lost a loved one or were hurt.
• How close you were to the event.
• How strong your reaction was.
• How much you felt in control of events.
• How much help and support you got after the event.

Having a history of mental illness, substance use disorder, or childhood trauma may also increase your risk of getting PTSD.

PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. About half of people who develop PTSD get better at some time. But other people who develop PTSD always will have some symptoms.^{footnote 1}

If you have symptoms of PTSD, counselling can help you cope. Your symptoms don't have to interfere with your everyday activities, work, and relationships. It is never too late to get professional help or other forms of support that can help you manage the symptoms of PTSD.

Reminders and anniversaries of the event can make symptoms worse.

How is PTSD treated?

Treatments for PTSD include:

• Counselling, which can help you understand your thoughts and learn ways to cope with your feelings. This can help you feel more in control and get you back to the activities in your life. A type of counselling called cognitive-behavioural therapy (CBT) is effective for treating PTSD. Cognitive processing therapy and prolonged exposure therapy are examples of types of CBT that are used.
• Antidepressant medicines, especially selective serotonin reuptake inhibitors (SSRIs). They can help with many PTSD symptoms. SSRIs include fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).

You may need to try different types of treatment before finding the one that helps you. Your doctor will help you with this. These treatments may include other types of medicines and other forms of counselling, such as group counselling. If you have other problems along with PTSD, such as overuse of alcohol or drugs, you may need treatment for those also.

Treatment can help you feel more in control of your emotions, have fewer symptoms, and enjoy life again.

Symptoms

Symptoms of post-traumatic stress disorder (PTSD) can be terrifying. They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day.

PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you may have PTSD.

Even if you always have some symptoms, counselling can help you cope. Your symptoms don't have to interfere with your everyday activities, work, and relationships.

Most people who go through a traumatic event have some symptoms at the beginning but don't develop PTSD.

There are four types of symptoms:

Reliving the event

Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger: a sound or sight that causes you to relive the event. Triggers might include:

• Hearing a car backfire, which can bring back memories of gunfire and war for a combat veteran.
• Seeing a car crash, which can remind a crash survivor of his or her own crash.
• Seeing a news report of a sexual assault, which may bring back memories of assault for someone who was sexually assaulted (raped).

Avoiding situations that remind you of the event

You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.

• A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes.
• A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants.
• Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.

Feeling bad about yourself or others

You may find it hard to express your feelings. This is another way to avoid memories.

• You may not have positive or loving feelings toward other people and may stay away from relationships.
• You may blame yourself for what happened. You may feel guilt, fear, or shame.
• You may forget about parts of the traumatic event or not be able to talk about them.

Feeling keyed up

You may be alert and on the lookout for danger. This is known as increased emotional arousal. It can cause you to:

• Suddenly become angry or irritable.
• Have a hard time sleeping.
• Have trouble concentrating.
• Have reckless behaviour or to think about hurting yourself.
• Fear for your safety and always feel on guard.
• Be very startled when someone surprises you.

Other symptoms

Other symptoms also may include:

• Physical symptoms for no reason you can think of (called somatic complaints).
• Difficulty controlling your emotions.
• Problems with family or friends.
• Impulsive or self-destructive behaviour.
• Changed beliefs or changed personality traits.

PTSD in children and teens

Children can have PTSD too. They may have the symptoms listed above and/or symptoms that depend on how old they are. As children get older, their symptoms are more like those of adults.

• Young children may become upset if their parents are not close by. Or children may have trouble sleeping or suddenly have trouble with toilet training or going to the washroom.
• Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may have fears and anxiety that don't seem to be caused by the traumatic event.

If you think you or a loved one has symptoms of PTSD, see your doctor right away. Treatment can work, and early treatment may help reduce long-term symptoms.

Military Concerns

If you were in the military, you may have seen combat. You may have been on missions that exposed you to horrible and life-threatening experiences. You may have been shot at, seen a buddy shot, or seen death. These are types of events that can lead to post-traumatic stress disorder (PTSD).

Other things about a combat situation can add more stress to an already stressful situation and may contribute to PTSD and other mental health problems.^{footnote 2} These things include what you do in the war, the politics around the war, where it's fought, and the type of enemy you face.

Another cause of PTSD in the military can be military sexual trauma (MST). This is any sexual harassment or sexual assault that occurs while you are in the military. MST can happen to men and women and can occur during peacetime, training, or war.

Getting treatment

Many veterans don't seek treatment for PTSD. You may feel that treatment won't help, or worry about what people will think. Your military background may add other pressures that keep you from seeking treatment. You may feel that it will hurt your career, or that those in your unit will lose faith in you. You may fear that your unit will see you as weak.

Tests and Treatments

There are many types of treatment for post-traumatic stress disorder (PTSD). You and your doctor will discuss the best treatment for you. You may have to try a number of treatments before you find one that works for you.

A type of counselling called cognitive-behavioural therapy and medicines known as SSRIs appear to be the most effective treatments for PTSD. Treatment can help you feel more in control of your emotions and result in fewer symptoms, but you may still have some bad memories.

Counselling means talking with a therapist on your own or in a group about the traumatic event and PTSD. You will talk with your therapist about your memories and feelings. This will help you change how you think about your trauma. You will learn how to deal with painful feelings and memories, so you can feel better.

Counselling

There are different types of . Several types of therapy have been shown to be effective in treating PTSD. These therapies are:

• Cognitive therapy, in which you learn to change thoughts about the trauma that are not true or that cause you stress.
• Prolonged exposure therapy, in which you talk about the traumatic event over and over, in a safe place, until you have less fear.
• Cognitive processing therapy, in which you learn to change negative emotions and thoughts related to the trauma.
• Eye movement desensitization and reprocessing (EMDR), in which you focus on hand movements and sounds while talking about the traumatic event.

Finding a therapist you trust is important. A good therapist will listen to your concerns and help you make changes in your life. Your doctor can help you find one. If you are a veteran, Veterans Affairs Canada is a good place to start. Churches sometimes offer services that help people get counselling. Or you can call your local health unit.

SSRI medicine

SSRIs (selective serotonin reuptake inhibitors) are a type of antidepressant medicine. They can help with many PTSD symptoms. They appear to be helpful, and for some people they are very effective. SSRIs include fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Other types of treatment

Your doctor also may suggest you try other types of medicines and other forms of counselling.

• include group treatment and family therapy.
• Other types of medicines include:^{footnote 3}
  • Other antidepressants like venlafaxine (Effexor) may also be used.
  • Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil).
  • Mood stabilizers such as carbamazepine (Tegretol). Mood stabilizers are sometimes taken with other medicines used for PTSD.
  • Antipsychotics such as risperidone (Risperdal). These medicines may help with symptoms like nightmares or flashbacks. More research is needed to find out how well these drugs work.
  • Prazosin (Minipress), which is used for nightmares and sleep problems related to PTSD.

If you are using medicine, take it exactly as prescribed. Call your doctor if it's not helping your symptoms or if the side effects are very bad. You and your doctor will decide what to do.

Some people who have PTSD may try complementary or alternative treatments to manage their symptoms. These treatments may include acupuncture, meditation, and hypnotherapy. These treatments may be helpful for some people with PTSD. But more research is needed.

Talk with your doctor about any complementary health practice that you would like to try or are already using.

Deciding to get treatment

Unfortunately, many people don't seek treatment for PTSD. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

Treatment can make your symptoms less intense and stop them from coming back. It can help you connect with your family, friends, and community. Many people get better with treatment.

When you first see your therapist, he or she will ask questions about the traumatic event causing PTSD and how severe your symptoms are. You may want your spouse, your partner, or a close family member to come with you. This person can help your doctor understand your symptoms and can help your therapist understand what you've been going through. Being with someone you trust helps you relax.

If you have other problems along with PTSD, such as overuse of alcohol or drugs, you also may need treatment for those problems.

Recovery

Recovery from PTSD does not mean forgetting the past trauma. It does mean that you learn how to not have the bad physical and emotional reactions in response to memories so that you can fully live your life. Recovery is not a cure. It helps you believe that you can reach your goals and learn new things to help yourself. It helps you gain self-confidence and respect for yourself.

The make you the most important part of your recovery. Your counsellor, doctor, family, and medicines can help you, but you're the one who makes the decisions. In the recovery process, you learn to cope with your symptoms and challenges and to develop social support.

Positive coping skills

Coping is about dealing with your symptoms. When you cope with your symptoms in a positive way, you often feel more in control. You accept what the traumatic event did and take steps to improve your life.

• Learn about PTSD to better understand how and why it affects you.
• Relieve stress to relax and feel less anxious.
• Exercise and be active to reduce how tense you feel. People who are fit usually have less anxiety, depression, and stress than people who aren't active.
• Get enough sleep to help your mood and make you feel less stressed. Many people with PTSD have trouble sleeping because they feel nervous and anxious or can't stop thinking about the traumatic event.
• Eat a balanced diet to help your body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.
• Find things to do to ease your memories and reactions. Consider channelling your emotions into activities or sports, painting or writing, or a rewarding job.
• Identify your beliefs to keep you balanced. PTSD can cause a spiritual crisis. You may begin to question your own beliefs and values and ask yourself why war or disasters happen. If this happens to you, talk to a family member, friend, or spiritual advisor. Consider spiritual study, prayer, or meditation.

Negative coping skills

Negative coping skills are certain ways you may try to deal with your symptoms and problems that cause more harm than good. These are quick fixes that don't improve your situation in the long run. They include drinking too much, avoiding others, and lashing out.

Support groups and social support

There are times when you may need a shoulder to cry on or a ride to the doctor. You may want to learn more about PTSD or talk with others who have PTSD. You need people who understand what you are going through and will help you and care about you. This is your support network.

Support takes many forms. You can find it in seminars and groups led by professionals, in groups made up of others with PTSD, and in your relationships with family and friends.

Emotional Health and Well-Being

Post-traumatic stress disorder (PTSD) doesn't always occur alone. Other medical conditions often occur with it, such as:

• Substance use disorder.
• Depression.
• Suicide.
• Anger and fear.
• Grief.
• Panic attacks.
• Physical health problems.

One Man's Story: "I didn't know why I needed to drink or wanted to drink. But Vietnam was never very far away when I did." —Ron

Family and Community

Post-traumatic stress disorder (PTSD) can harm your relationships with your family and community. Feelings of anger and depression and not wanting to deal with people can make it hard to connect with them. Pay attention to how you act with your family and try not to pull away. Your relationships can make a big difference in your recovery from PTSD.

Here are things you can do to help yourself, your family, and your community better understand and deal with PTSD.

• Know when to get crisis help. Sometimes you need help right away. This may be the case when you have had thoughts about suicide or if anger turns to rage.
• . Your family plays an important part in your recovery from PTSD. But you also have to help them. This means:
  • Talking to your family about PTSD and what it does to you.
  • Talking to your kids. Be sure they know they aren't to blame.
  • Talking about your triggers. Triggers are places, sounds, and sights that can cause symptoms. They can be locations, social events, or holidays.
• Remember that life transitions, even positive ones such as getting married, having a baby, or starting a new job, can cause stress and result in more PTSD symptoms.
• Keep in mind that your relationship to your community can be changed by PTSD.

Your family and community are part of your recovery. Do as much as you can to work with them. With knowledge, your family and community can better help you.

One Man's Story: "Talking about it with my wife is getting easier. The more I talk about it with people, the better." —Tim

What can others do to help?

Your family and community are part of your recovery. Do as much as you can to work with them. With this knowledge, your family and community can better help you.